Atrial cardiopathy confers elevated risk for dementia
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Atrial cardiopathy was associated with increased risk for dementia, according to new data from the ARIC cohort study.
There was little mediation of the effect by atrial fibrillation or stroke, according to the researchers.
Michelle C. Johansen, MD, PhD, assistant professor of neurology at Johns Hopkins University School of Medicine, and colleagues analyzed 5,078 participants who completed the fifth visit in the ARIC cohort study from 2011 to 2013.
Vascular contributions to dementia
“There is growing evidence that the way we thought of Alzheimer’s disease and dementia is a little more complex than we originally thought, and that vascular contributions to dementia are very important,” Johansen told Healio. “Atrial fibrillation has been linked to dementia, but atrial cardiopathy, which is a state of atrial dysfunction apart from atrial fibrillation, had not been linked to dementia before. In recognizing that vascular risk plays an important role in the way people are thinking, and that we have to do a better job than we are currently at trying to prevent the onset of cognitive decline, we decided to do the study.”
Participants were deemed to have atrial cardiopathy if they met at least one of the following criteria: P-wave terminal force of at least 5,000 mV x ms in ECG lead V1; N-terminal pro-B-type natriuretic peptide of at least 250 pg/mL; or left atrial volume index of at least 34 mL/m2 on transthoracic echocardiography.
After using Cox regression to determine the relationship between atrial cardiopathy and dementia, the researchers used structural equation modeling methods to determine to what extent the relationship was mediated by AF and stroke.
Among the cohort (mean age, 75 years; 59% women; 21% Black), 34% had atrial cardiopathy, and there were 763 participants who developed dementia during mean follow-up of 6.12 years, the researchers wrote.
Atrial cardiopathy was associated with elevated risk for dementia (adjusted HR = 1.35; 95% CI, 1.16-1.58), and the relationship was even stronger when participants met at least two of the criteria for atrial cardiopathy (aHR = 1.54; 95% CI, 1.25-1.89), according to the researchers.
When participants with AF were excluded, atrial cardiopathy remained associated with dementia (aHR = 1.31; 95% CI, 1.12-1.55), and the same was true when participants with stroke were excluded (aHR = 1.28; 95% CI, 1.09-1.52), Johansen and colleagues wrote.
The researchers determined that AF mediated 4% of the effect of atrial cardiopathy on dementia (P = .005) and stroke mediated 9% of the effect (P = .048).
Knowing vascular risk
“Atrial cardiopathy is a concept that has only been defined since 2014,” Johansen told Healio. “We are still trying to figure out exactly how to implement that in clinical care. Knowing your vascular risk is important. As time goes on, we should have a better understanding about what that actually means. Right now, we look for atrial cardiopathy through symptomatic heart conditions, but it may be that a subclinical state of atrial dysfunction is enough to over time lead to these changes we are seeing in cognition.”
There is not yet enough evidence to say that atrial cardiopathy causes dementia, but the study, which was carefully controlled for confounders, pointed to an association between them, Johansen told Healio.
For more information:
Michelle C. Johansen, MD, PhD, can be reached at mjohans3@jhmi.edu.
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